Football Games with Limited Attendance Not Associated with COVID-19 Spread

Counties that hosted professional and college football games with limited in-person attendance during the COVID-19 pandemic didn’t see a substantial increase in COVID-19 cases, a new study found.

The study, published in JAMA Network Open, analyzed US counties that hosted NFL and NCAA football games to estimate the association between games with limited in-person attendance and spread of COVID-19.

A total of 528 games (101 NFL and 427 NCAA) were included in the study, which also included a matched control group with 361 counties similar in size and COVID-19 restrictions that did not host a game on the corresponding day. For NFL games, attendance ranged from 6,000 to 13,797, with a median of 9,949. NCAA attendance wasn’t available.

“We surmise that the NFL and NCAA policies regarding limited in-person attendance, mask use, and social and physical distancing measures in stadiums was not associated with substantially higher community spread of COVID-19,” the authors, led by Asmae Toumi, BS, of Massachusetts General Hospital, wrote. “Additionally, an important number of NFL and NCAA football stadiums are outdoors or have a retractable roof, which could have had an impact on mitigating spread.”

On game day, the median daily new COVID-19 cases in counties that hosted football games was 26.14 cases per 100,000 residents compared with 24.11 cases per 100,000 residents for counties in the control group. The change in number of cases within 14 days after game day ranged from -5.17 to 4.72 cases per 100,000 residents, with a mean of 1.21.

“Our study provides evidence suggesting that in-person attendance of football games with social distancing and mask use could be resumed in the 2021 to 2022 season,” the authors wrote. “However, it is worth noting that newly emerging variants of SARS-CoV-2 have less predictable implications at this point and might lead to more disruptive interruptions in the future.”

Limitations of the study included that attendance was considered as a binary variable since in-person attendance wasn’t available for NCAA games. The study also didn’t control for other large events or the possibility of spillover to adjacent counties.

“Studies such as that by Toumi et al, which add to our understanding of the virus and its transmission, are essential for providing decision-makers with the information needed to design and enact policies that align with evidence and protect people in the community,” Michael A. Rubin, MD, PhD, MS, of the Salt Lake City Health Care System and the University of Utah School of Medicine, said in an invited commentary. “More like it are needed as the United States and other countries confront the mounting political and societal pressure of regaining a sense of normalcy that comes with returning our large and beloved sports arenas to full—and full-throated—capacity.”

The US Food and Drug Administration’s full approval of the Pfizer-BioNTech COVID-19 vaccine granted Mondayalso could boost events. Former FDA Commissioner Mark McClellan, MD, PhD, told Contagion® he expects more vaccine requirements at venues such as indoor dining, sports and entertainment venues. McClellan is the Robert J. Margolis Professor of Business, Medicine, and Policy, and founding Director of the Duke-Margolis Center for Health Policyat Duke University.

Sports venues have been areas of concern during the pandemic, with some worrying games could become super spreader events. A study from West Virginia University published last year found that US cities saw influenza mortality rates increase between 5% and 24% during the professional football, basketball, hockey, and baseball seasons.